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Predicting Severe Postoperative Respiratory Complications following Abdominal Wall Reconstruction

Blatnik, Jeffrey A. M.D.; Krpata, David M. M.D.; Pesa, Nicholas L. M.D.; Will, Peter B.S.; Harth, Karem C. M.D., M.H.S.; Novitsky, Yuri W. M.D.; Rowbottom, James R. M.D.; Rosen, Michael J. M.D.

Plastic and Reconstructive Surgery: October 2012 - Volume 130 - Issue 4 - p 836–841
doi: 10.1097/PRS.0b013e318262f160
Reconstructive: Trunk: Original Articles
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Background: Patients undergoing abdominal wall reconstruction are at risk of developing major postoperative respiratory complications. The authors attempted to identify factors predictive of respiratory complications following abdominal wall reconstruction.

Methods: All patients who underwent complex abdominal wall reconstruction over a 2-year period were reviewed. The primary endpoint studied was severe respiratory complication, defined as respiratory insufficiency requiring intubation or transfer to a higher level of care.

Results: Sixty patients underwent complex abdominal wall reconstruction during the study period. The incidence of respiratory complications was 20 percent. Factors predictive of postoperative respiratory complication included age (p = 0.05), American Society of Anesthesiologists score (p = 0.04), and hernia defect size (p = 0.01). In addition, patients who developed respiratory complications were more likely to have had a greater change in plateau pressure (5.8 versus 2.3 cmH2O; p = 0.01). The greater the change in plateau pressure, the greater the risk of developing a respiratory complication: for a change in plateau pressure greater than or equal to 6 cmH2O, the odds ratio was 8.67; for a change in plateau pressure greater than or equal to 9 cmH2O, the odds ratio was 11.5.

Conclusions: Respiratory complications following abdominal wall reconstruction can be serious and are associated with prolonged hospitalizations. Patients with an increase in their plateau pressure of greater than 6 cmH2O are at an increased risk of severe postoperative respiratory complications.


Cleveland, Ohio

From the Departments of Surgery and Anesthesiology, University Hospitals Case Medical Center.

Received for publication April 27, 2012; accepted April 27, 2012.

Disclosure:Dr. Novitsky is a speaker for LifeCell Corporation and Davol and is a consultant for Davol and Kensey Nash. Dr. Rosen is a speaker for LifeCell. Research support was received from LifeCell, Davol, W. L. Gore & Associates, and Cook.

Michael J. Rosen, M.D., Department of Surgery, University Hospitals Case Medical Center, 11100 Euclid Avenue, Mailstop 5047, Cleveland, Ohio 44106,

©2012American Society of Plastic Surgeons